Too poor to pay for care, this man eventually lost his leg to snakebite infection.
This villager survived but lost a leg to infection.
Lao Luong Village - Hin Boun District - Khammouan Province - Lao Peoples Democratic Republic
Yai and I often meet villagers who have health conditions that have lingered for months or years without treatment. We meet long-suffering people who could have relief from pain if they only knew where to find therapy and rehabilitation. We meet people who have learned that medical help is available in a distant city but who lack the knowledge and courage to travel or the means to finance a trip. When we can, Yai and I lead villagers to available help.
Recently Yai and I were barreling down Route 13, the main north-south highway in Laos, making good time and feeling increasingly confident that we could make it up the mountain and onto the Nakai Plateau before nightfall. Then, ahead of us, we saw a small man hobbling down the road. He moved with an odd gait, appearing to hop rather than walk. In spite of his unusual stride, he moved along at a pretty good clip.
Yai and I have learned to anticipate each other’s impulses. Without so much as a questioning glance in my direction, Yai hit the brake and squealed to a stop next to the man; we bounded out of the cab to greet him. As we suspected, the fellow was missing a leg. His bouncing, lopsided walk was the result of his using a single crutch to vault down the road; he literally advanced himself by leaps and bounds.
As is my custom, I introduced myself and my work by pointing out the colorful logo on my shirt that declares to the world “Phoenix Clearance Limited,” does “Landmine and Bomb Disposal”. As always, Yai quickly issued our standard disclaimer: “We do bombs. We don’t do arms and legs. But we know people who help people get new arms and legs”. (Experience has taught us that unless we bluntly state the limits of our interest and ability, we get can get dragged into problems that take us way out of our depth).
Tired and out of breath, the man slid down his crutch and lowered himself to the roadside. As soon as his hands were free, he pressed his palms together at eye level and politely gestured a “nop”, the simple demonstration of respect that Lao people commonly offer when greeting one another. We introduced ourselves as Yai and Jim. He told us his name was Pang and that he lived in Ban Lao Luong, the next village up the road.
Foregoing all Lao rules of etiquette we cut right to the chase and asked Pang how he came to have just one leg. He explained that ten or eleven years ago a snake bit him on the lower leg. Yai and I had planned to keep this conversation short since we were racing darkness to Nakai but, sharing a common dread of snakebite, we decided to invest a little time to learn more about snakes, bites, and available treatments.
Pang told us that after the snake nailed him on the shin, he immediately collapsed in pain and had to be carried back to his village. At home, he was delirious for several days, and could neither eat nor drink. Somehow, he survived that initial crisis but continued to suffer for weeks as his foot and leg slowly withered away. It was only when certain death was approaching that he gave up on “local medicine” and sought care at the provincial hospital in Tha Khaek, a desperate step taken only after consultation with his extended family since it would take resources from many relatives to cover the expense. At the hospital doctors told Pang to choose either his life or his leg. He chose life and surgeons amputated his infected leg mid-thigh; treating the bite at home had cost Pang his knee.
We asked Pang why he never got a “plastic leg”. He first laughed at our question but then politely explained, as we suspected, that after the expense of his treatment his family was flat broke. In the years since, he had never accumulated enough money to consider himself in the market for a new leg. He simply learned to do without.
We told Pang that our friends at the Cooperative Orthotic and Prosthetic Enterprise in Vientiane, better known as COPE, might be able to help him get an artificial leg. Pang acknowledged that he had heard of a place in Vientiane that provided new legs to amputees but he shyly confessed that he didn’t know how to find help in such a big city and that, in any case, he had no means of getting to Vientiane or supporting himself once he got there.
When Yai asked Pang if he’d be interested in getting help in Vientiane if we could take him to the city, introduce him to the right people, and arrange payment for a leg, his reaction was, essentially, “Can we leave today?”
Using a map drawn in the dirt, Yai pointed out that, unfortunately, we were heading away from Vientiane. But we offered Pang encouragement by assuring him that sometime in the near future we would travel this road again, heading toward Vientiane. We told Pang that if he were truly motivated we’d take him to the National Rehabilitation Center and get him help from our friends at COPE. We cautioned him that he might have to remain at the center for several weeks and that he might need new surgery to prepare his stump to receive a prosthesis. Pang assured us that he could contend with whatever it might take to get a plastic leg.
Yai learned from Pang that there was a fellow in Lao Luong who owned a cell phone and was usually willing to relay messages to his neighbors. We headed into the village to meet this man and to ask if we could call upon him to deliver a message when the time came, giving Pang notice to be packed and ready to travel. To our disappointment, the guy was not at home. Fortunately, his neighbors confidently told us we could count on the favor and gave us the man’s cell phone number. Thus passes for planning in Laos.
Weeks later, events unfolded just as Yai and I had predicted. The day before we departed Nakai for Vientiane we called the phone guy and asked him to relay our message: “Jim and Yai are coming back. Get ready to go. We’ll pick you up tomorrow before noon”. We asked the fellow to remind Pang on our behalf, that if he still bought into our plan he should be prepared to be away from home for a month or more.
The next morning, there sat Pang on his doorstep. Apparently his packing for the trip had not taken much effort; he carried whatever he thought he might need for the month in a tiny rucksack the size of a kindergartner’s school bag. (Sadly, his pack probably contained not all the clothes he thought he needed, but all the clothes he owned).
There was just one hitch. Pang asked if we might consider taking Mye, his uncle, to Vientiane as well. Uncle Mye, he explained, had also had a run-in with a snake. (In fact, the same species that attacked Pang). Uncle Mye had been bitten three years ago, had suffered greatly, but had never received treatment other than herbal teas and poultices. Pang said that the collective medical wisdom of the village was that Uncle Mye needed an amputation. We agreed to go meet the man and at least have a look at his foot.
It was not a pretty sight. Necrosis had reduced Uncle Mye’s foot to perhaps half its original size, and left it discolored, somewhat resembling a ripe mango gone bad. Yai and I both guessed that the man would indeed need an amputation, but we modestly stuck to our disclaimer: “We do bombs, not legs” and kept our diagnosis to ourselves.
In Laos, there is always room for one more in a truck, so we told Uncle Mye that if he didn’t mind a crowded seat he could come along. It took him about two minutes to pack. If anything, he had fewer possessions than Pang. As the two guys squeezed into the back seat of our truck, along with their crutches, packs, my luggage, and some de-mining equipment, Yai got a hearty laugh from them when he asked pointedly whether they had enough legroom.
COPE does a terrific job on behalf of patients. If they make their own way to Vientiane on public transportation the organization reimburses their bus fare. At the Rehab Center, they provide patients with a comfortable bed in a dormitory as well as a modest daily allowance for food, which can be bought from a canteen on the center grounds or from food stalls outside the main gate.
Although the daily food allowance is small (equal to about US $1.25) patients find they can buy two meals a day if they limit themselves mostly to rice and vegetables. People I’ve brought to the center from the provinces usually tell me that what they miss most while living in the city are the foods that they find back home while foraging: fruits and nuts, roots and wild greens, insects, frogs, fish, birds and other small animals.
I usually use “good deed money” donated by American schools and churches to supplement the allowance that patients receive from COPE, so the villagers I deliver can enjoy small luxuries such bath soap, laundry detergent, drinking water, and tobacco. I’ve found that an extra half-dollar (5,000 Kip) a day goes a long way toward making villagers feel comfortable as they wait for services.
Within 48 hours of his arrival at the center, the professional staff evaluated Pang and judged him to be an excellent candidate for an above-the-knee prosthesis. Luckily, due to the healthy condition of his stump, Pang will need no additional surgery. COPE will pay the full cost of his artificial leg and the training that he will need in order to make proper use of it.
To my surprise, the therapists were impressed with the flexibility and range of motion that Uncle Mye has retained in his withered foot. Pointing out that a “bad foot” is better than “no foot” they advised against an immediate amputation and suggested that, instead, they fit Uncle Mye with a specially designed orthopedic shoe. Given the choice, Uncle Mye accepted the therapists’ recommendation; he’s going to try the shoe for a while before yielding to the surgeon’s knife.
I checked on the guys on my last day in Vientiane. They’d been at the center for less than a week but, true to our predictions, they were looking a bit forlorn. (Villagers that we take to the Rehab Center always arrive happy but are miserably homesick a few days later. We always warn them about homesickness and they always tell us it won’t be a problem. I think villagers underestimate the impact of homesickness for the simple reason that they’ve never experienced it before; most have never spent more than a few nights away from their village!) The saving grace for Pang and Uncle Mye is that for the next few weeks they will have each other for familiar company.
Both guys now own new crutches: manufactured at the center, made to measure, and provided free of charge. Each has found a fellow patient who has a condition similar to his own. They are hearing success stories and witnessing progress in others that will surely raise their spirits. I’m confident that in spite of the hardships ahead Pang and Uncle Mye will find the courage to see their adventure through to the end.